| NPI | 1811238124 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MI 5601009727) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL PA9106826) |
| Enumeration Date | 2013-03-12 |
| Last Update Date | 2020-12-03 |